November 2017

TMHP Enrollment Due by December 31 to Continue Receiving Reimbursements for CHIP Services

The Texas Health and Human Services Commission (HHSC) requires providers who currently render services to Children's Health Insurance Program (CHIP) members through a Managed Care Organization (MCO) complete enrollment with the Texas Medicaid & Healthcare Partnership (TMHP) by December 31, 2017. Providers can designate in their enrollment applications that they intend to serve only CHIP members. CHIP providers are encouraged to enroll using the Provider Enrollment on the Portal. While the enrollment process and application are the same for Medicaid and CHIP providers, CHIP-only providers are not required to participate in Texas Medicaid. CHIP-only providers must follow these instructions to indicate they only intend to serve CHIP members and to ensure that they do not appear on the Medicaid online provider lookup.

LTSS Prior Authorization Checklist

To help with the LTSS prior authorization process, a checklist for requesting prior authorization is available on our website. The checklist highlights what is needed when requesting authorization for Private Duty Nursing. Providers should include all the information from the checklist when requesting an authorization. Missing or incomplete information may cause a delay in processing the request. If you have any questions, please contact STAR Kids Utilization Management Intake at 877-784-6802.

eviCore healthcare^TM Web Portal Enhancement

Rather than calling or faxing, you can now use the online portal to submit additional clinical information to existing prior authorizations.

Increasing Awareness of Prenatal and Postpartum Care in Travis County

To help combat the rise in maternal deaths in the U.S. over the last 20 years, Blue Cross and Blue Shield of Texas (BCBSTX) is implementing a performance improvement project for prenatal and postpartum care. Our goal is to improve the timeliness of prenatal and postpartum care among BCBSTX STAR members in Travis county.

Tuberculosis: A Surprisingly High Occurrence

For the past several years, Texas is one of four states that reported more than 500 active cases of tuberculosis (TB), which accounted for 50.9 percent of reported cases nationwide. Learn how you can assist the CDC in eradicating new cases of TB in the U.S.

835 Electronic Remittance Advice (835 ERA) Update

Effective November 30, 2017, government programs providers enrolled to receive the 835 ERA from BCBSTX may request redelivery of missing ERA files to their designated receivers issued since Jan. 1, 2017. Please note that ERA files originally issued prior to January 1, 2017, cannot be reloaded.

EVV Policy Changes Due to Hurricane Harvey

HHSC and MCOs have issued temporary Electronic Visit Verification (EVV) policy changes as a result of Hurricane Harvey.

Recoupment of EVV Claims Without Valid EVV Transactions

STAR Kids EVV-related claims must include all required data elements. Claims submitted in the EVV system without the valid transaction data prior to receipt of claim payment will be recouped for dates of service including June 1, 2017, and after. See the following resources for more information, which are also posted on our website under News & Announcements:

• HHSC EVV Provider Information
• BCBSTX Provider Customer Service: 1-877-784-6802
• BCBSTX EVV mailbox for questions or concerns: BCBSTX_EVV_Questions@bcbstx.com

If you are a newly contracted provider or an existing provider who needs a refresher on one of these subjects, consider attending the following webinars. Please RSVP by the deadline.

Note: If you’re not able to attend any of the trainings below, they are available for completion via Brainshark at your own pace, date and time.